Morrical Brandon D, Dearani Joseph A, Bonnichsen Crystal R, Taggart Nathaniel W
Department of Pediatric Cardiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
Pediatr Cardiol. 2019 Apr;40(4):726-732. doi: 10.1007/s00246-019-02056-9. Epub 2019 Jan 30.
Repair of Ebstein anomaly has evolved over the last decade, and timing of repair remains variable. There have been no studies of exercise or functional capacity in patients who have had tricuspid valve surgery for Ebstein anomaly in adulthood. We aimed to compare exercise capacity before and after tricuspid valve repair or replacement for Ebstein anomaly in adults at Mayo Clinic. We performed a retrospective chart review of all patients with Ebstein anomaly who underwent tricuspid valve surgery at Mayo Clinic between June 2007 and January 2015. We compared pre- and postoperative echocardiograms, exercise tests, and clinic visits. Tricuspid valve surgery was done for 322 patients, and 32 patients met criteria of native tricuspid valve repair or replacement at age 18 or older and had maximal pre- and postoperative exercise tests. Nineteen patients had valve repair, and 13 had valve replacement. Surgery for Ebstein anomaly resulted in significant reduction in tricuspid regurgitation and right ventricular size. There was a significant improvement in NYHA functional class after surgery; however, there was no significant improvement in functional aerobic capacity (FAC), metabolic equivalents (METs), exercise time, or [Formula: see text] after surgery. Patients who had an atrial shunt closed during surgery had improved minimum blood oxygen saturations during exercise, though no improvement in exercise capacity. In our cohort, patients who had tricuspid valve repair or replacement for Ebstein anomaly reported an improvement in functional capacity; however, this did not reflect improvement in measured exercise capacity, despite excellent surgical results by echocardiography.
在过去十年中，埃布斯坦畸形的修复方法不断发展，修复时机也因人而异。目前尚无关于成年后因埃布斯坦畸形接受三尖瓣手术患者的运动或功能能力的研究。我们旨在比较梅奥诊所成年患者因埃布斯坦畸形接受三尖瓣修复或置换前后的运动能力。我们对2007年6月至2015年1月期间在梅奥诊所接受三尖瓣手术的所有埃布斯坦畸形患者进行了回顾性病历审查。我们比较了术前和术后的超声心动图、运动测试和门诊就诊情况。322例患者接受了三尖瓣手术，32例患者符合18岁及以上进行原生三尖瓣修复或置换的标准，并进行了最大程度的术前和术后运动测试。19例患者进行了瓣膜修复，13例患者进行了瓣膜置换。埃布斯坦畸形手术导致三尖瓣反流和右心室大小显著减小。术后纽约心脏协会（NYHA）心功能分级有显著改善；然而，术后功能性有氧能力（FAC）、代谢当量（METs）、运动时间或[公式：见正文]没有显著改善。手术期间关闭心房分流的患者在运动期间的最低血氧饱和度有所改善，但运动能力没有改善。在我们的队列中，因埃布斯坦畸形接受三尖瓣修复或置换的患者报告功能能力有所改善；然而，尽管超声心动图显示手术效果良好，但这并未反映出测量的运动能力有所改善。
